Reducing Asthma Triggers: Key to Asthma Control Pat McLaine, DrPH, MPH, RN University of Maryland School of Nursing October 23, 2015 Presentation to Maryland Nurses Association 112 th Annual Convention
Current Asthma Prevalence: United States, 2001-2010 Total number of persons in millions 26 24 22 20 18 16 14 12 10 8 6 4 2 0 Total number of persons Percent 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year 10 9 8 7 6 5 4 3 2 1 0 Percent Current Asthma Prevalence: United States, 2001-2010. See Figure 1 in National Surveillance of Asthma: United States, 2001-2010. For comparison among population subgroups, percentages were adjusted by age using the 2000 U.S. Census standard population. See Table 1 for underlying data.
http://www.cdc.gov/asthma/asthmadata.htm
Child and Adult Current Asthma Prevalence by Age and Sex: United States, 2006-2010 14 12 Children Adults Male Female 10 Percent 8 6 4 2 0 0-4 5-14 15-17 18-24 25-34 35-44 45-54 55-64 65+ Age group Current Asthma Prevalence: United States, 2001-2010. See Figure 1 in National Surveillance of Asthma: United States, 2001-2010. For comparison among population subgroups, percentages were adjusted by age using the 2000 U.S. Census standard population. See Table 1 for underlying data.
Asthma prevalence rates About 1 in 11 children and 1 in 12 adults has asthma. But rates differ across the country: United States 8.4% Maryland 11.9% Baltimore City 19.9% Reference: Youth Risk Behavior Surveillance Survey, 2007-2009, Asthma in Maryland 2012, DHMH; CDC Factsheet Asthma s Impact on the Nation
Translation to school class room
Asthma is expensive Asthma costs the United States $56 billion each year In 2008, asthma caused: 10.5 million missed days of school 14.2 million missed days of work The average yearly cost of care for a child with asthma was $1,039 in 2009 CDC Factsheet: Asthma s Impact on the Nation, http://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf
Asthma is deadly Nearly 10 people die from asthma every day 3,630 people died from asthma in 2013 Disparities by race: Race White NH 8.4 Black NH 25.9 Other NH 12.0 Hispanic 9.0 death rate/million population http://www.cdc.gov/asthma/most_recent_data.htm, National Asthma Mortality (2013) Source: CDC Wonder (http://wonder.cdc.gov/)
Asthma Has Large Impact on Healthcare In 2009 in the United States: 479,300 asthma-related hospitalizations 1.9 million asthma-related ED visits 8.9 million asthma-related doctor visits 1 in 5 US children with asthma received care in the ED in 2009 CDC Factsheet: Asthma s Impact on the Nation, http://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf
Asthma Disparities Multi-race and black adults are more likely to have asthma than white adults Black children are 2 times more likely to have asthma than white children Families living in poverty are more likely to have asthma than affluent families 1 in 4 black adults can t afford their asthma medications or routine doctor visits Black adults are 2 to 3 times more likely to die from asthma than any other racial/ethnic group
Black-White Disparity Ratio for Maryland Adults with Asthma, 2006 5 4.5 4.3 4 3.5 3 2.5 2.4 2.4 2 1.5 1.3 1 0.5 0 Prevalence ED Visits Hospitalization Mortality Source: Maryland BRFSS, HSCRC Vital Statistics Administration, The Maryland Asthma Control Plan, http://phpa.dhmh.maryland.gov/mch/documents/asthma_action_agenda.pdf
350.0 Asthma ED Visits (2010) 300.0 Rate (per 10,000 populatipon) 250.0 200.0 150.0 100.0 50.0 0.0 County Baseline Black/African American White (non-hispanic) Source: DHMH State Health Improvement
Poverty = Higher Asthma Prevalence Below federal poverty 10.9% 100-250% of poverty 7.0% 250-450% of poverty 6.2% >450% of poverty 6.6% http://www.cdc.gov/asthma/most_recent_data.htm Source: 2013 National Health Interview Survey (NHIS) http://www.cdc.gov/asthma/nhis/2013/table3-1.htm & http://www.cdc.gov/asthma/nhis/2013/table4-1.htm
Disparities in Baltimore City Children living in poverty: US 20.7% Maryland 11.3% Baltimore City 29.4% In Baltimore City, 62% live below 200% of poverty
NHLBI Keys to Asthma Control Assessment and monitoring Control of environmental exposure and triggers Medication controller and rescue Education of individual and family Asthma Action Plan Source: National Heart, Lung and Blood Institute (NHLBI) Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma
What individuals with asthma report In 2008, less than 50% of people with asthma were taught to avoid triggers! 1 In Maryland, in 2008, 29% of adults with asthma had an asthma action plan 2 In Maryland, in 2008, four percent (4%) of adults with asthma had taken an asthma management course 2 1 Asthma and Allergy Foundation of America 2 CDC s National Asthma Control Program, Asthma in Maryland Report, http://www.cdc.gov/asthma/stateprofiles/asthma_in_md.pdf
Evidence for home interventions Home-based interventions: multi-trigger, multicomponent interventions with environmental focus strong evidence for effectiveness for children: Improve asthma symptoms Reduce number of school days missed due to asthma Improving overall quality of life and productivity Insufficient evidence for effectiveness for adults Community Preventive Services Task Force, June 2008; http://www.thecommunityguide.org/asthma/multicomponent.html
Goals for today Recognize common asthma triggers in the home Identify control options Develop plan of action with the family to reduce exposures
Types of Asthma Triggers Allergens Irritants Colds/flu/viruses Exercise Some behaviors Weather extremes
Indoor Environment 90% of time spent indoors Indoor home environment not regulated May have very high levels of pollutants Ventilation may be inadequate Older housing more likely to contain asthma triggers 58.5% of Baltimore homes built before 1950* Housing in poor condition - 24% with leaky roofs** 37.2% with mice/rats; 16.2% with cockroaches *** * American Community Survey 2010 ** Breysee, P et al, Environmental Research, Vol 98 (2) 2005 *** 2009 Baltimore City Community Health Survey
Allergens Pests Dust mites Mold, mildew Pets with fur or feathers Pollen Food
Pests
Signs of Cockroaches
Signs of Mice
Where to look
Comparative sizes
Control for Rodents and Roaches Food, water, shelter Clean up crumbs, spills Trash can with tight lid Store food in air-tight containers Fix leaks and drips Clear away clutter Eliminate pests Trap mice Use bait and roach hotels Keep them out! Seal cracks and holes in walls Repair screens Check door sweeps to be sure they hit floor Clean up Clean up frass and mouse urine (hot water, detergent)
Setting mouse traps
Roach Bait consumer, professional
Dust Mites Microscopic animals Live in carpets, mattresses, pillows, stuffed animals, upholstered furniture, curtains Feces and skeletons are allergenic
Control for dust mites Allergen-proof mattress and pillow covers Wash bedding weekly in hot water, dry Non-washables in freezer for 24 hours/week Use damp cloth to dust Use damp mop not broom Avoid clutter Change filters HVAC HEPA vacuum Remove carpeting
Mold/Mildew Control options Use hot water and detergent to clean nonporous surfaces Find source of moisture (fix the leak) Replace porous building materials if wet 24-48 hours or if moldy Use exhaust fans Look at house plants too
Common Sources of Moisture
Pets with fur or feathers Control options Keep pet out of room where person with asthma sleeps Use HEPA vacuum several times/week Bathe pets Find a new home for the pet
Pollen Control Options Close windows, use AC Shower and rinse hair before bed Stay indoors during peak times (5 AM 10 AM) or if dry, windy Don t hang clothes out to dry Use walk-off mats at entrance doors
On-line Pollen Information National Allergy Bureau Pollen and Mold Report Location: Baltimore, MD Date: April 28, 2014 NAB Station: Drs. Golden and Matz, LLC Top 3 Species: All identified tree pollen not counted elsewhere (Other Tree Pollen) http://www.aaaai.org/g lobal/nab-pollencounts.aspx www.pollen.com Top 3 Species: All identified weed pollen not counted elsewhere (Other Weed Pollen) pollen/mold app: pollen.aaaai.org Top 3 Species: All identified grass pollen not counted elsewhere (Other Grass Pollen)
Food Allergies Food allergies can trigger respiratory response. Obesity is risk factor for asthma Diets low in vitamins, high in fat associated with: > asthma symptoms < response to med Control options Get allergy testing Use food labels Eat variety of colored fruits and vegetables Limit fried food and sugar Eat low fat meats
Irritants Tobacco smoke Strong fumes and scents Perfumes and personal products Household cleaning products Bug spray, pesticides, paint, gasoline Combustion by-products (gas stoves, NOX) Pollution
Tobacco Smoke Smoke is an asthma trigger Tobacco smoke contains lead, butane, ammonia Smoke from fire place and fires can also trigger asthma symptoms Smoking during prenatal period can affect child s health after birth Asthmatics more likely to smoke than non-asthmatics Low income households smoke more
Smoking control strategies Encourage smoking cessation Maryland Quitline: 1-800-QUIT NOW Educational programs Medical care Do not allow smoking inside the home or car Smoke outside and use a smoking jacket remove when come in
Strong fumes and scents Sources include: Perfumes Cleaning products Air fresheners Cooking fumes (frying) Smelly soaps and lotion Hairspray Scented candles Bug spray, pesticides Paint Gasoline
Fumes and scents control strategies Use green cleaning products vinegar, baking soda, borax, hot water to clean Use fragrance-free products Use kitchen fan or window when cooking Cook when asthmatic not in kitchen Use low or no VOC paints Make sure rooms are well ventilated, especially when being cleaned
Combustion By-Products Gas appliances are associated with higher levels of nitrous oxides (NOX) Replacement of gas appliances with electric stove has been associated with lower levels of exposure
Outdoor Pollution Many sources: Industrial Power plant Vehicle traffic Symptoms may be delayed to the day after exposure and can increase sensitivity to other triggers.
Outdoor Pollution control strategies Promote anti-idling policies at schools, bus depots Keep windows closed if high-traffic area Monitor air quality: www.airnow.gov Stay indoors if air quality is poor, ozone is high (afternoons, evenings on hot summer days) Moderate exercise only on days when air quality problematic Ozone levels healthier in morning than afternoon Exercise away from busy roads, industrial areas
Colds, flu, viruses Respiratory infections and colds can be asthma triggers, especially in children Control strategies: Encourage frequent hand washing Get a flu shot Keep people with asthma away from people with colds Treat respiratory and other infections promptly
Exercise, behaviors Exercise can trigger an asthma episode Extreme laughing, crying, anger and stress can also trigger an asthma reaction Control options: Discuss options for medication with provider, warm up slowly Behavioral calming techniques: deep breathing
Weather extremes Asthma can be triggered by weather: Very cold Very warm Very humid Changes in the weather
Control strategies for weather In cold weather: use scarf to cover nose and mouth (warms up inhaled air) On hot humid days: stay indoors in AC Plan outdoor activities in advance to avoid triggers Higher temperatures also can affect air quality and pollution levels
Climate Change Global Warming has resulted in higher temperatures for longer periods of time This has increased both the amount of allergens in the air and the duration of allergy season. Impacts on Asthma triggers: Increased amount and allergenicity of allergens Increased concentration of ozone Increased fine particles and dust Increased temperatures Increased rate of ozone formation due to higher temperature and increased sunlight Increased precipitation, increased mold spores Increased droughts, increased dust and particulate matter http://www.niehs.nih.gov/research/programs/geh/climatechange/health_impacts/asthma/index.cfm
Control strategies for climate change Educate yourself and get involved: Carbon footprint personal, family, work, school Alliance of Nurses for a Healthy Environment Climate Change and Health Community http://envirn.org/pg/gro ups/7007/climatechange-and-health/ Nurse Charlotte Wallace, with President Obama on April 7, 2015
Questions?
Thank You Baltimore City Health Department United States Environmental Protection Agency